contact vulvitis due to pseudowintera colorata in a topical herbal medicament

Sir, Besides traditional topical and systemic pharmacological treatments for the therapy of vulvovaginal yeast and bacterial infections, numerous over-the-counter medicaments containing natural substances (e.g. tea tree oil, echinacea, sodium caprylate, propolis) are marketed. Patients often prefer alternative medicine and selfprescribe herbal-based products. We report here an unusual case of acute vulvitis that occurred in a young patient after prolonged topical use of an antifungal herbal preparation

low dose acitretin in treatment of plaque type psoriasis descriptive study of efficacy and safety

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Antropoestratigrafía: nuevas unidades litológicas del Cuaternario controladas por la actividad humana

Many areas around the world such as the Mediterranean region have been inhabited without interruption for thousands of years. This is the case of the city of Barcelona (Spain), where remains of human settlements dating from pre-Roman times until the present have been found. A detailed geological mapping of the area occupied by the city of Barcelona raises a number of questions about the Holocene stratigraphy affected by human activity. In the old urban and surrounding areas most of the sedimentary deposits accumulated during settlement result from human interactions. Thus, new anthropostratigraphic units are proposed. The sedimentary deposits and the infill of rock excavations due to human presence may be divided into three categories: Natural lithoanthropogenic units (NAU) when their formation is not directly affected by anthropogenic activity but these contain artefacts of human origin. Induced lithoanthropogenic units (IAU) when natural processes together with human actions produce sedimentation or erosion due to natural phenomena; Constructed lithoanthropogenic units (CAU) when sedimentary accumulations and sharp contacts result from direct human activity.A lo largo de todo el globo terrestre, existen muchas zonas como la región mediterránea que han sido habitadas ininterrumpidamente durante miles de años. Este es el caso de la ciudad de Barcelona donde se han encontrado restos de asentamientos humanos desde los tiempos pre-romanos hasta la actualidad. Un mapa geológico detallado de la zona ocupada por la ciudad de Barcelona plantea una serie de interrogantes sobre la estratigrafía del Holoceno influenciado por la actividad humana. En la zona urbana antigua y en áreas circundantes, la mayoría de los depósitos acumulados durante el asentamiento se han producido por las interacciones humanas. Por tanto, se proponen nuevas unidades antropoestratigráficas. Los depósitos sedimentarios así como los rellenos de lasexcavaciones debidos a la presencia humana pueden ser divididos en tres categorías: Unidades litoantropogénicas naturales (NAU) cuando su generación no ha sido afectada directamente por la actividad humana, pero contienen diversos artefactos artificiales. Unidades litoantropogénicas inducidas (IAU) cuando los procesos naturales junto a las acciones humanas producen sedimentación o erosión debido a los fenómenos naturales. Unidades litoantropogénicas construidas (CAU) cuando las acumulaciones sedimentarias y los contactos nítidos son el resultado de la actividad humana directa

Ab interno trabecular bypass surgery with Schlemm´s canal microstent (Hydrus) for open angle glaucoma

Background: Glaucoma is a leading cause of irreversible blindness. A number of minimally‐invasive surgical techniques have been introduced as a treatment to prevent glaucoma from progressing; ab interno trabecular bypass surgery with the Schlemm's canal Hydrus microstent is one of them. / Objectives: To evaluate the efficacy and safety of ab interno trabecular bypass surgery with the Hydrus microstent in treating people with open angle glaucoma (OAG). / Search methods: On 7 May 2019, we searched CENTRAL (2019, Issue 5), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov; and the WHO ICTRP. / Selection criteria: We searched for randomised controlled trials (RCTs) of the Hydrus microstent, alone or with cataract surgery, compared to other surgical treatments (cataract surgery alone, other minimally‐invasive glaucoma device techniques, trabeculectomy), laser treatment, or medical treatment. / Data collection and analysis: A minimum of three authors independently extracted data from reports of included studies, using a data collection form and analysed data, based on standard Cochrane methods. / Main results: We included three published studies, with 808 people randomised. Two studies had multiple international recruitment centres in the USA and other countries. The third study had several sites based in Europe. All three studies were sponsored by the Hydrus manufacturer Ivantis Inc. All studies included participants with mainly mild or moderate OAG (mean deviation between ‐3.6 dB (decibel) and ‐8.4 dB in all study arms), which was controlled with medication in many participants (mean medicated intraocular pressure (IOP) 17.9 mmHg to 19.1 mmHg). There were no concerns regarding allocation concealment bias, but masking of outcome assessors was high or unclear risk in all studies; masking of participants was achieved, and losses to follow‐up were not a concern. Two studies compared the Hydrus microstent combined with cataract surgery to cataract surgery alone, in participants with visually significant cataracts and OAG. We found moderate‐certainty evidence that adding the Hydrus microstent to cataract surgery increased the proportion of participants who were medication‐free from about half to more than three quarters at 12‐month, short‐term follow‐up (risk ratio (RR) 1.59, 95% confidence interval (CI) 1.39 to 1.83; 2 studies, 639 participants; I² = 0%; and 24‐month, medium‐term follow‐up (RR 1.63, 95% CI 1.40 to 1.88; 2 studies, 619 participants; I² = 0%). The Hydrus microstent combined with cataract surgery reduced the medium‐term mean change in unmedicated IOP (after washout) by 2 mmHg more compared to cataract surgery alone (mean difference (MD) ‐2.00, 95% CI ‐2.69 to ‐1.31; 2 studies, 619 participants; I² = 0%; moderate‐certainty evidence), and the mean change in IOP‐lowering drops (MD ‐0.41, 95% CI ‐0.56 to ‐0.27; 2 studies, 619 participants; I² = 0%; low‐certainty evidence). We also found low‐certainty evidence that adding a Hydrus microstent to cataract surgery reduced the need for secondary glaucoma surgery from about 2.5% to less than 1% (RR 0.17, 95% CI 0.03 to 0.86; 2 studies, 653 participants; I² = 27%; low‐certainty evidence). Intraocular bleeding, loss of 2 or more visual acuity (VA) lines, and IOP spikes of 10 mmHg or more were rare in both groups; estimates were imprecise, and included both beneficial and harmful effects. There were no cases of endophthalmitis in either group. No data were available on the proportion of participants achieving IOP less than 21 mmHg, 17 mmHg, or 14 mmHg; health‐related quality of life (HRQOL), or visual field progression. One study provided short‐term data for the Hydrus microstent compared with the iStent trabecular micro‐bypass stent (iStent: implantation of two devices in a single procedure) in 152 participants with OAG (148 in analyses). Use of the Hydrus increased the proportion of medication‐free participants from about a quarter to about half compared to those who received iStent, but this estimate was imprecise (RR 1.94, 95% CI 1.21 to 3.11; low‐certainty evidence). Use of the Hydrus microstent reduced unmedicated IOP (after washout) by about 3 mmHg more than the iStent (MD ‐3.10, 95% CI ‐4.17 to ‐2.03; moderate‐certainty evidence), and the use of IOP‐lowering medication (MD ‐0.60, 95% CI ‐0.99 to ‐0.21; low‐certainty evidence). Both devices achieved a final IOP < 21 mmHg in most participants (Hydrus microstent: 91.8%; iStent: 84%; RR 1.09, 95% CI 0.97 to 1.23; low‐certainty evidence). None of the participants who received the Hydrus microstent (N = 74) required additional glaucoma surgery; two participants who received the iStent (N = 76) did. Few adverse events were found in either group. No data were available on the proportion of participants achieving IOP less than 17 mmHg or 14 mmHg, or on HRQOL. / Authors' conclusions: In people with cataracts and generally mild to moderate OAG, there is moderate‐certainty evidence that the Hydrus microstent with cataract surgery compared to cataract surgery alone, likely increases the proportion of participants who do not require IOP lowering medication, and may further reduce IOP at short‐ and medium‐term follow‐up. There is moderate‐certainty evidence that the Hydrus microstent is probably more effective than the iStent in lowering IOP of people with OAG in the short‐term. Few studies were available on the effects of the Hydrus microstent, therefore the results of this review may not be applicable to all people with OAG, particularly in selected people with medically uncontrolled glaucoma, since IOP was controlled with medication in many participants in the included studies. Complications may be rare using the Hydrus microstent, as well as the comparator iStent, but larger studies are needed to investigate its safety

Study of a New Trigger on Multiplicity and Primary Interaction Vertex using the ALICE Silicon Pixel Detector

New trigger inputs for the ALICE Central Trigger Processor (CTP) are proposed. They are based on the use of Fast Multiplicity (FM) output signals generated by the ALICE Silicon Pixel Detector (SPD). These can be used for a multiplicity based centrality trigger and for a fast on-line computation of the primary vertex. A simple algorithm for primary vertex location at the trigger level is proposed. The precision that can be achieved with this method on centrality selection and primary vertex location, is discussed for interactions with different pseudo-rapidity density level. The feasibility of background rejection is also considered

E-cigarettes and youth: an unresolved Public Health concern

The use of electronic cigarettes (e-cigarette) and vaping devices started as a potential aid for cessation and reducing the harmful consequences of cigarette smoking, mainly in the adult population. Today e-cigarette use is highly increasing in vulnerable populations, especially young and pregnant women, due to the misconception of its harmless use.Despite the growing acknowledgment in e-cigarette as a potential harmful device, and due to mixed information found concerning its beneficial aid for smokers, along with an insufficient clinical study done in human models, it is important to further evaluate the possible benefits and risks of non-combusting, vaping nicotine or non-nicotine delivery devices.In this review we tried to summarize the latest updated information found in the literature, concentrating mainly in the variety of adverse effects of e-cigarette use and its contribution for recent and future health concerns

Short Communication. Embryo yield in llamas synchronized with two different intravaginal progesterone-releasing devices and superovulated with eCG

The objectives of this study were to compare the effects of two intravaginal devices (ID) containing the same dose (0.5 g) of progesterone (P4) on subsequent ovarian response, embryo production and circulating P4 concentration profile in llamas (Lama glama) treated with equine chorionic gonadotropin (eCG) for ovarian superstimulation. Female llamas were randomly assigned (n = 10 llamas per group) to one of the following groups and treated (Day 0) with an ID containing 0.5 g of vegetal P4 to synchronize the emergence of a new follicular wave: i) DIB 0.5® and ii) Cronipres M15®. On Day 3 llamas were intramuscularly treated with 1000 IU of eCG. The IDs were removed on Day 7. Llamas were naturally mated (Day 9) and treated with GnRH analogue to induce ovulation. A second mating was allowed 24 h later. Embryos were collected between 7 and 8 days after the first mating. Blood samples were taken every day from Day 0 to Day 7 to measure circulating P4 concentrations. The results indicated that DIB device maintained greater plasma P4 levels as compared to Cronipres until Day 2. However, the mean (± SD) number of corpora lutea and recovered embryos was not affected (p &lt; 0.05) by the type of ID (5.3 ± 2.6 vs 4.2 ± 2.2 and 3.5 ± 2.7 vs 2.6 ± 3.0 for DIB and Cronipres, respectively). In conclusion, both DIB and Cronipres devices can be successfully used to synchronize the emergence of follicular wave prior to a single dose of eCG in superovulation protocol in llamas

Optic nerve head and fibre layer imaging for diagnosing glaucoma

Background The diagnosis of glaucoma is traditionally based on the finding of optic nerve head (ONH) damage assessed subjectively by ophthalmoscopy or photography or by corresponding damage to the visual field assessed by automated perimetry, or both. Diagnostic assessments are usually required when ophthalmologists or primary eye care professionals find elevated intraocular pressure (IOP) or a suspect appearance of the ONH. Imaging tests such as confocal scanning laser ophthalmoscopy (HRT), optical coherence tomography (OCT) and scanning laser polarimetry (SLP, as used by the GDx instrument), provide an objective measure of the structural changes of retinal nerve fibre layer (RNFL) thickness and ONH parameters occurring in glaucoma. Objectives To determine the diagnostic accuracy of HRT, OCT and GDx for diagnosing manifest glaucoma by detecting ONH and RNFL damage. Search methods We searched several databases for this review. The most recent searches were on 19 February 2015. Selection criteria We included prospective and retrospective cohort studies and case-control studies that evaluated the accuracy of OCT, HRT or the GDx for diagnosing glaucoma. We excluded population-based screening studies, since we planned to consider studies on self-referred people or participants in whom a risk factor for glaucoma had already been identified in primary care, such as elevated IOP or a family history of glaucoma. We only considered recent commercial versions of the tests: spectral domain OCT, HRT III and GDx VCC or Data collection and analysis We adopted standard Cochrane methods. We fitted a hierarchical summary ROC (HSROC) model using the METADAS macro in SAS software. After studies were selected, we decided to use 2 x 2 data at 0.95 specificity or closer in meta-analyses, since this was the most commonly-reported level. Main results We included 106 studies in this review, which analysed 16,260 eyes (8353 cases, 7907 controls) in total. Forty studies (5574 participants) assessed GDx, 18 studies (3550 participants) HRT, and 63 (9390 participants) OCT, with 12 of these studies comparing two or three tests. Regarding study quality, a case-control design in 103 studies raised concerns as it can overestimate accuracy and reduce the applicability of the results to daily practice. Twenty-four studies were sponsored by the manufacturer, and in 15 the potential conflict of interest was unclear. Comparisons made within each test were more reliable than those between tests, as they were mostly based on direct comparisons within each study. The Nerve Fibre Indicator yielded the highest accuracy (estimate, 95% confidence interval (CI)) among GDx parameters (sensitivity: 0.67, 0.55 to 0.77; specificity: 0.94, 0.92 to 0.95). For HRT measures, the Vertical Cup/Disc (C/D) ratio (sensitivity: 0.72, 0.60 to 0.68; specificity: 0.94, 0.92 to 0.95) was no different from other parameters. With OCT, the accuracy of average RNFL retinal thickness was similar to the inferior sector (0.72, 0.65 to 0.77; specificity: 0.93, 0.92 to 0.95) and, in different studies, to the vertical C/D ratio. Comparing the parameters with the highest diagnostic odds ratio (DOR) for each device in a single HSROC model, the performance of GDx, HRT and OCT was remarkably similar. At a sensitivity of 0.70 and a high specificity close to 0.95 as in most of these studies, in 1000 people referred by primary eye care, of whom 200 have manifest glaucoma, such as in those who have already undergone some functional or anatomic testing by optometrists, the best measures of GDx, HRT and OCT would miss about 60 cases out of the 200 patients with glaucoma, and would incorrectly refer 50 out of 800 patients without glaucoma. If prevalence were 5%, e.g. such as in people referred only because of family history of glaucoma, the corresponding figures would be 15 patients missed out of 50 with manifest glaucoma, avoiding referral of about 890 out of 950 non-glaucomatous people. Heterogeneity investigations found that sensitivity estimate was higher for studies with more severe glaucoma, expressed as worse average mean deviation (MD): 0.79 (0.74 to 0.83) for MD &lt; -6 db versus 0.64 (0.60 to 0.69) for MD &gt;=-6 db, at a similar summary specificity (0.93, 95% CI 0.92 to 0.94 and, respectively, 0.94; 95% CI 0.93 to 0.95; P &lt; 0.0001 for the difference in relative DOR). Authors' conclusions The accuracy of imaging tests for detecting manifest glaucoma was variable across studies, but overall similar for different devices. Accuracy may have been overestimated due to the case-control design, which is a serious limitation of the current evidence base. We recommend that further diagnostic accuracy studies are carried out on patients selected consecutively at a defined step of the clinical pathway, providing a description of risk factors leading to referral and bearing in mind the consequences of false positives and false negatives in the setting in which the diagnostic question is made. Future research should report accuracy for each threshold of these continuous measures, or publish raw data